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Report on the NSW Government's Implementation of the Recommendations of the Royal Commission into Aboriginal Deaths in Custody
Maintain comprehensive and up-to-date information on Aboriginal health programs That the State, Territory and Commonwealth governments act to put an end to the situation where insufficient accurate and comprehensive information on inputs to and activities of Aboriginal health programs is available. Such information is needed if Aboriginal organisations, governments and the community are to be in a position to understand and monitor what is taking place in this area, to estimate the benefits derived therefrom and to develop appropriate policies and programs to address existing and newly emerging needs. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report NSW Health has been involved in various national projects which aim to provide greater information regarding inputs and activities in Aboriginal health, most notably the National performance indicators for Aboriginal and Torres Strait Islander health and the National Aboriginal and Torres Strait Islander Health Information Plan. An important achievement under the NSW Health Information Strategy (AHIS) in 1998 was the launch of the NSW Aboriginal Health Information Guidelines, a document designed to ensure better practice in the management of health and health-related information about Aboriginal and Torres Strait Islander peoples in New South Wales. The Guidelines were developed in partnership with the Aboriginal Health Resource Co-operative, and were the result of extensive consultation with service providers in the public and Aboriginal community controlled health sectors. The Guidelines outline key principles and values to consider in the collection, management, and reporting of Aboriginal health information, including issues such as privacy, confidentiality, data ownership, access and use. Importantly, this document is a “first” for health jurisdictions in Australia. Implementation of the Guidelines across the health sectors is fundamental to restoring confidence and trust in the use of Aboriginal health information in New South Wales. It is on this firm base that the remaining AHIS projects are being progressed. The AHIS will deliver more accurate information regarding inputs and activities, as a result of improvements in the recording of Aboriginality in various data collections (see Recommendation 68). Improved measures of inputs to Aboriginal health will also be realised at the Area Health Service level through performance indicators to be negotiated in 1999. Discussions have commenced with the Aboriginal Health Resource Co-operative regarding ways of assisting Aboriginal Community Controlled Health Services to identify and meet their information needs. Implementation status Partially implemented Future reporting in Part A
Improved and increased training in health care That more and/or better quality training be provided in a range of areas taking note of the following:
(b) The rotation of staff through country hospitals means that many professional staff are ill-prepared to provide appropriate health care services to Aboriginal people. Staff on such rotations should receive special training for their rural placements, and resources to make this possible should routinely be provided as part of the operating budgets of the relevant facilities; (c) The primary health care approach to health development is highly appropriate in the Aboriginal health field, but health professionals are not well trained in this area. The pre-service and in-service training of doctors, nurses and other health professionals should provide such staff with a firm understanding of and commitment to primary health care. This should be a special feature of the training of staff interested in working in localities where Aboriginal people are concentrated; (d) Health care staff working in areas where Aboriginal people are concentrated should receive specific orientation training covering both the socio-cultural aspects of the Aboriginal communities they are likely to be serving and the types of medical and health conditions likely to be encountered in a particular locality. Such orientation programs must be complemented by appropriate on-the-job training; (e) Effective communication between non-Aboriginal health professionals and patients in mainstream services is essential for the successful management of the patients’ health problems. Non-Aboriginal staff should receive special training to sensitise them to the communication barriers most likely to interfere with the optimal health professional/patient relationship; and (f) Aboriginal people often present to mainstream health care facilities with unusual health conditions and unusual presentations of common conditions, as well as urgent, life-threatening conditions. The training of health professionals must enable them to cope successfully with these conditions. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report The Department of Health finalised the development of a Cultural Awareness Package in 1996. The package was distributed to all Area Health Services in late 1997. Cultural Awareness Training is a requirement in Area Health Service Performance Agreements. The Cultural Awareness Training Package is to support Area Health Services in developing training programs that incorporate local issues. Area Health Services are advised the cultural awareness training should be presented by Aboriginal staff and in collaboration with members of the local Aboriginal communities. Guidelines for implementation and review were not incorporated in the process and have been left to individual Area Health Services. The failure to provide implementation guidelines has resulted in varying outcomes, which was reflected in a survey conducted by the Department. The survey also revealed an inconsistency in approach to cultural awareness training. Therefore, a working party was established to review the package including the feasibility of developing a new cultural awareness package and or developing materials to supplement the current package. The working party has just completed draft core standards – “Aboriginal Cultural Awareness Programs for the NSW Public Health System”. The “Core Standards” will provide Area Health Services with core program topics and a uniform approach to developing and delivering Aboriginal cultural awareness programs. Further information in relation to cross cultural training provided by NSW Health is contained in Chapter 3 of Part A. It should be noted that as the Commonwealth Government is responsible for the provision of tertiary education, the content of university health courses such as medicine and nursing is a matter for the Commonwealth Government. Implementation status Partially implemented Future reporting in Part A
Aboriginal community-controlled heath services to be studied That health departments, academic institutions and other relevant training authorities monitor the proposed Monash University Victorian Aboriginal Health Services Aboriginal Primary Health Care Unit, with a view to learning from its experiences and that those interested in this field study the philosophies and methods of operation of the Aboriginal community-controlled health services. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report The historic partnership with the NSW Health and NSW Aboriginal Health Resource Co-operative (AHRC), continues to enhance opportunities for communities themselves to actively address their health needs and to be involved in improving health and restoring physical, social, emotional and cultural well-being. Formal quarterly meetings that make recommendations on issues of policy, planning and allocations, continue. Representatives of the AHRC continue to participate in Department of Health working parties and advisory groups to ensure representation of the community. The Partnership has led to improved co-ordination and collaboration in the delivery of health services to the Aboriginal people of New South Wales. Implementation status Partially implemented Future reporting in Part A
Communication between mainstream and Aboriginal community based health care services That effective mechanisms be established for communicating vital information about patients, between the mainstream and Aboriginal community-based health care services. This must be done in an ethical manner, preserving the confidentiality of personal information and with the informed consent of the patients involved. Such communication should be a two-way process. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report The NSW Aboriginal Health Information Guidelines, launched in August 1998, aim to ensure consistency in the management of health and health-related information about Aboriginal people in New South Wales (see Recommendation 246). The Guidelines address ethical issues surrounding the collection, ownership, storage, access, release, usage, reporting and interpretation of information, as well as issues of confidentiality and privacy. Information to support operationalisation of the Guidelines is currently under development. The Aboriginal Health Resource Co-operative Ethics Committee has also undertaken to make available information about its processes to assist the health sector in submitting relevant proposals requiring ethical consideration from an Aboriginal perspective. Implementation status Partially implemented Future reporting in Part A
Increased access to health care services and facilities That access to health care services and facilities, including specialised diagnostic facilities, in areas of Aboriginal population should be brought up to community standards. The greater needs, for the time being, of Aboriginal people should be fully recognised by the responsible authorities in their consideration of the allocation of staff and equipment. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report Ensuring Progress in Aboriginal Health: A Policy for the NSW Health System includes establishing standards of delivery for culturally appropriate service delivery. During 1999 the NSW Health Department will also finalise and implement the NSW Aboriginal Health Strategic Plan. Development of the Strategic Plan is taking place in collaboration with major stakeholders including the NSW Aboriginal Health Resource Co-operative and the Commonwealth Department of Health and Aged Care. The Plan will implement Ensuring Progress in Aboriginal Health, providing agreed directions for the improvement of Aboriginal health service planning, delivery and performance management for the next three to five years. Evaluation of the Plan will be assessed by monitoring the identified outcomes through a range of existing reporting processes, including the Chief Health Officer’s Report; NSW Health’s report to the Commonwealth on performance indicators on Aboriginal health; Area Health Service performance agreements; local partnerships; and, a range of reports required under this Plan. Employment of Aboriginal Health Co-ordinators in Area Health Services with significant Aboriginal populations also assists to improve access to health services. All Area Health Services with significant Aboriginal population employ Aboriginal Health Co-ordinators. At present fifteen of the sixteen Area Health Services have Aboriginal Health Co-ordinators. Aboriginal Health Co-ordinators provide policy advice to management, plan, facilitate and monitor and evaluate mainstream health service provision in Aboriginal health. Aboriginal Health Co-ordinators are also members of the NSW Aboriginal Health Partnership, which advises the NSW Government on Aboriginal health matters. There are plans for Aboriginal Health Co-ordinators to be employed in the remaining Area Health Service, Corrections Health, New Children Hospital and the NSW Ambulance Service. The ongoing employment of Aboriginal Hospital Liaison Officers and implementation of the Cultural Awareness Package also assist better access to services for Aboriginal people. The employment of Aboriginal Hospital Liaison Officers is a matter for Area Health Services in accordance with their Aboriginal Health and Aboriginal Employment Plans. Twenty two Aboriginal people are also represented on all Area Health Service Boards where there is a significant Aboriginal population. Implementation status Partially implemented Future reporting in Part A
Aboriginal people to be involved in decisions relating to health service delivery That health departments and other mainstream health authorities accept as policy, and implement in practice, the principle that Aboriginal people should be involved in meaningful ways in decision making roles regarding the assessment of needs and the delivery of health services to the Aboriginal community. One application of this principle is that efforts should be made to see that Aboriginal people are properly represented on the Boards of hospitals serving areas where Aboriginal patients will be a significant proportion of hospital clients. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report The Partnership between NSW Health and the NSW Aboriginal Health Resource Co-operative (AHRC), continues to enhance opportunities for communities themselves to actively address their health needs and to be involved in improving health and restoring physical, social, emotional and cultural well-being. The Partnership Agreement ensures that the expertise of Aboriginal communities is brought to health care processes in New South Wales. The Partnership has also led to improved co-ordination and collaboration in the delivery of health services to the Aboriginal people of New South Wales. Area Health Services are also establishing Partnerships with local Aboriginal community controlled health organisations to advise on service delivery and resource allocation at the Area level. This recommendations is also addressed through the Framework Agreement on Aboriginal and Torres Strait Islander Health 1996-2000, signed in August 1996 by New South Wales, the Commonwealth, the AHRC and ATSIC, in accordance with the principles of the National Commitment to Improved Outcomes in the Delivery of Programs and Services for Aboriginal People and Torres Strait Islanders. The Agreement is to promote co-operation between State, Commonwealth and community groups on Aboriginal health. The NSW Aboriginal Health Forum, established following this Agreement consists of representatives of the NSW Health, the NSW Aboriginal Health Resource Co-operative, the Federal Department of Health and Aged Care, and the Aboriginal and Torres Strait Islander Commission. The NSW Aboriginal Health Forum and the NSW Aboriginal Health Partnership (between NSW Health and the AHRC) work together to improve collaboration and co-ordination between the State and Commonwealth Governments and the Aboriginal community controlled sector. It will help to ensure that decisions are made within Aboriginal terms of reference and an understanding of NSW Aboriginal community control. The appointment of Aboriginal people to all Area Health Service Boards where there is a significant Aboriginal population continues to addresses this recommendation. There are currently 22 Aboriginal people on Area Health Service Boards across New South Wales. An Aboriginal Board Member Network has been established to support Aboriginal Board Members in their role. A meeting of Aboriginal Board Members was held on 24 November 1998. Nine members attended. A number of outcomes were reached and recommendations made, including a seminar conducted on Aboriginal Health issues for mainstream Board Members, and the need for Network meetings to be held annually. The NSW Partnership Forum advises the Minister on jointly agreed positions relating to policy, planning and broad resource allocation. It has increased the participation of Aboriginal people in these areas. The Aboriginal Health Resource Co-operative (AHRC) is invited to nominate a representative for all policy and planning working parties. Outcomes at the statewide level include the joint approval of:
Implementation status Partially implemented Future reporting in Part A
Encourage Aboriginal people to undertake medical and health care studies That special initiatives now in place in a number of tertiary training institutions, such as medical schools, to facilitate the entry into and successful completion of courses of study and training by Aboriginal students be expanded for use in all relevant areas of health services training. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Education and Training Implementation report The Commonwealth Government is primarily responsible for implementing this recommendation. At a State level, TAFE NSW provides the following:
Certificates II – IV in Aboriginal and Torres Strait Islander Health are new courses currently being implemented in TAFE. These courses were developed by the Community Services, Health, Tourism, and Hospitality Educational Services Division in conjunction with the Aboriginal Programs Unit. The Statement of Attainment in Community Audiometry for Aboriginal Health Workers provides students with the skills and knowledge to perform relevant hearing testing, maintain hearing equipment in working order, and promote hearing health in the Aboriginal community. Implementation status Partially implemented Future reporting in Part A
Increased collection and use of Aboriginal health statistics That:
(b) Appropriate Aboriginal health advisory bodies (such as the proposed Council of Aboriginal Health) consider developing an expanded role in this area, perhaps in an advisory capacity to the Australian Institute of Health, and that the aim of this involvement should be to ensure that priority is given to the collection, analysis, dissemination and use of those Aboriginal health statistics most relevant to Aboriginal health development. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report Consistent with the principles and spirit of the NSW Aboriginal Health Partnership, representatives from NSW Health and the NSW Aboriginal Health Resource Co-operative have continued to collaborate or work jointly on several projects designed to improve Aboriginal health statistics. They include the national performance indicators for Aboriginal and Torres Strait Islander Health, the National Indigenous Health Information Plan, the Australian Bureau of Statistics proposed Indigenous Statistics Program, and the NSW Aboriginal Health Information Strategy (AHIS). During 1998 the AHIS also extended its Aboriginal consultation processes to include representation of ATSIC and Office of Aboriginal and Torres Islander Health (OATSIH) on the NSW Aboriginal Health Information Management Group, to commence discussions with the NSW Aboriginal Land Council, and to liaise with other peak Aboriginal health bodies interstate (eg Aboriginal Health Council of South Australia) about health-related information projects. Implementation status Partially implemented Future reporting in Part A
Funding of implementation of the National Aboriginal Health Strategy That the implementation of the National Aboriginal Health Strategy, as endorsed by the Joint Ministerial Forum, be regarded as a crucial element in addressing the underlying issues the Commission was directed to take into account, and that funds be urgently made available to allow the Strategy to be implemented. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report A NSW Aboriginal Health Strategic Plan is being developed by the Department of Health in collaboration with the Aboriginal community and the Commonwealth. The Plan will set priorities and directions for the next three years and support implementation of the National Aboriginal Health Strategy and the NSW Aboriginal Health Policy. The Plan will be finalised for endorsement by the Aboriginal Health Partnership and released during 1999. This recommendation is also addressed through the employment of special project officers to implement the following innovative programs: environmental health; information data base systems, family and child health, and otitis media. Implementation status Partially implemented Future reporting in Part A
Provision of early intervention programs in health centres That the possibility of establishing early intervention programmes in Aboriginal health services and in hospitals and community health centres with a high proportion of Aboriginal patients be investigated. This would include the training needs of staff in intervention techniques. Government’s original position: Supported Revised government position: Supported Agencies responsible for implementation: Department of Health Implementation report In 1998 an Aboriginal Health Education Officer and Aboriginal Health Liaison Officer State Conference was held to enable input into the identification of issues, priorities and future directions, including personal development and service delivery. The State conference was primarily concerned with the identification and discussion of issues that will enable Aboriginal Health Workers to work more effectively in Areas. Issues discussed include: Partnerships, Aboriginal Health Policy, Aboriginal Heath Strategic Plan, Stolen Generation, Otitis Media, Aboriginal Family Health Strategy, Planning, Aboriginal Mental Health Strategy, Aboriginal Employment Strategy and Public Health. There was no specific session on early intervention programs. A conference report has been compiled and distributed to all Aboriginal Health Workers for comment before it is finalised. Health workers have also been requested to provide feedback on establishment of a formal network and how to proceed with addressing the conference recommendations. The Department’s Aboriginal Employment Strategy will also address the professional development of these officers through the introduction of a career path structure and increased opportunities eg adaptation of Aboriginal Health Workers and Torres Strait Islander Health Workers competency based standards. Aboriginal Hospital Liaison Officers To improve access to health services by Aboriginal people the Department of Health has created, by issue of seeding grants, Aboriginal Hospital Liaison positions to those hospitals that service significant Aboriginal communities. It is now the obligation of the Area Health Services to maintain these positions. Implementation status Partially implemented Future reporting in Part A |
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